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Complications of suppurative otitis media

Complications of suppurative otitis media






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    Complications of suppurative otitis media Complications of suppurative otitis media Presentation Transcript

    • COMPLICATIONS C.S.O.M.Dr. Mohammad Aslam Chaudhry Professor E.N.T (BBH)
    • Anatomical review
    • “Medial wall of middle ear”
    • Surgeon’s view
    • Complications of CSOM• classification 1. Cranial (Intra-temporal ) 2. Extra-cranial complications 3. Intra-cranial complications
    • Pre-disposing factors• Age• Virulent organisms• Cholesteatoma or Bone erosion• Presence of a congenital dehiscence• Obstruction of drainage e.g polyp• Low resistance of the patient• Poor socio-economic status
    • Routes of spread
    • Pathways of infections• The commonest way for extension of infection is by bone erosion due to a cholesteatoma.• Vascular extension (retrograde thrombophlebitis). • Extension along preformed pathways as– Congenital dehiscences, fracture lines, round window membrane, the labyrinth,– Dehiscences due to previous surgery.
    • COMPLICATIONS OF CSOM Routs of spread
    • Cranial complications (Intratemporal )1. Mastoiditis2. Petrositis3. Labyrinthitis4. Facial paralysis5. Perilymphatic fistula
    • Mastoiditis• Inflammation of mastoid air cells• Acute vs Chronic• Fever• 2 weeks after OM• Earache• Irritability
    • Labyrinthitis• • Infection of the inner ear• • SNHL• • Vertigo• • Nausea and vomiting
    • labyrinthitis
    • Tympanosclerosis• Asymptomatic• Indicator of OM• Ear drum stiffness• Ossicular fixation
    • Tympanosclerosis
    • • 56 yr • Earache• Chronic Discharge
    • Facial Paralysis• Slow – chronic expansion of disease• Rapid – infected cholesteatoma• With cholesteatoma requires immediate surgery• CT localizes involved portion
    • Facial ParalysisManagement• Mastoidectomy, Remove cholesteatoma and infected debris• IV antibiotics and +/- steroids.
    • Petrositis• Only in pneumatised petrous pyramids• Infected petrous cells• Poor drainage• Bony coalescence → symptoms
    • • GRADENIGO• Retro-orbital pain• Abducent→ Diplopia• Discharge
    • Extra-cranial complications• Otitis externa• Cervical lymphadenitis• Retropharyngeal &• Parapharyngeal abscesses
    • Impending sign @ symptoms• Decreased mental status• Stiff neck• Ataxia• Visual changes• Seizures• Other Headache, lethargy, fever.
    • INTRACRANIAL COMLICATIONS• Barriers penetration1. Bone→ Epidural Abscess→ LST2. Dura Mater→ Subdural Abscess3. Arachnoid→Meningitis4. Pia Mater→ Brain Abscess
    • Lateral Sinus Thrombosis (sigmoid sinus)Spread of infection by direct extension orvia mastoid emissary vein ↓ Pus and granulation adjacent to sigmoidsinus ↓ Reactive thrombophlebitis ↓ intraluminal thrombus ↓ CSF obstruction
    • Signs of LST• Picket-fence fever 􀃆• Papilledema• Torticollis• Greisinger sign →
    • LST• LST is rare complication• CT• Angiography• MRI- MRV
    • LST ……Treatment• Empiric broad coverage until C&S• antibiotic with good CSF penetration• Surgery – Mastoidectomy – Decompression – Thrombus evacuation
    • Intracranial Epidural Abscess• Localized between dura and bone• dural adherence to bone at suture lines• Focal osteomyelitis• Management and etiology same as subdural empyema
    • Subdural Abscess• Between the dura and the arachnoid.• Potential space• Lack of anatomical boundaries→ spread rapidly• Ear 14%• (paranasal sinusitis 75%)
    • Subdural Abscess - clinical• Fever• Focal neurological deficit• Headache• Seizures• Forehead or eye swelling from emissary vein thrombosis• Vomiting
    • Subdural Abscess - evaluation• CT of head both with and without contrast• LP - hazardous - risk of transtentorial herniation
    • Meningitis
    • Meningitis: Clinical Manifestations• Headache• Nuchal rigidity• Fever and chills• Photophobia• Vomiting• Seizures• Focal neurologic symptoms• Altered sensorium (confusion, delirium, or declining level of consciousness)
    • Physical ExaminationKernig & Brudzinski signs have low sensitivity but high specificity
    • Brain Abscess - Clinical Presentation• non-specific Symptoms for abscess• increased intracranial pressure• –Headache,• –Nausea/Vomiting• – Lethargy.• – Seizures.
    • Otic hydrocephalusSymptoms• Non-specific• Headache• Tinnitus• Nausea / vomiting• Visual disturbance• Others – lethargy, dizziness, mood change
    • TX• Decrease the IC pressure – Corticosteriods – Acetazolamide – Lumbar pucture• I/V Antibiotics• Mastoidectomy